It’s a frustratingly common story. You’re halfway through a solid chest workout, feeling the pump, when suddenly that sharp, nagging pinch hits the front of your shoulder. Maybe it’s a dull ache that only shows up when you lower yourself down. Or perhaps it’s a weird clicking sensation that doesn't necessarily "hurt" but feels like something is about to snap. Shoulder pain with push ups is basically the tax many people pay for trying to get fit without understanding how the glenohumeral joint actually functions under load.
The shoulder is a mechanical nightmare. It’s a ball-and-socket joint, but unlike the hip—which is deep and stable—the shoulder is more like a golf ball sitting on a tiny tee. We sacrifice stability for massive range of motion. When you throw 150+ pounds of body weight into a repetitive pushing motion, things can go south fast if your mechanics are even slightly off.
Honestly, most people just "do" push ups. They drop down, flare their elbows out to 90 degrees, and crank out reps until they smell toast. That’s a recipe for impingement. If you're feeling that bite in the joint, you aren't alone, but you also shouldn't ignore it. Pain is a signal, not a challenge.
The Impingement Trap: What’s Actually Happening?
When we talk about shoulder pain with push ups, the most frequent culprit is subacromial impingement syndrome. Inside your shoulder, there’s a narrow space called the subacromial space. This is where your rotator cuff tendons and a fluid-filled sac called a bursa live.
When you perform a push up with "T-frame" arms—where your elbows are pointing straight out to the sides—the head of your humerus (upper arm bone) jams upward. This narrows that tiny gap. It literally pinches the tendons against the acromion bone. Do this 50 times a day, three days a week, and you’ve got a chronic inflammatory party that nobody invited.
But it’s not always impingement. Sometimes it’s the AC joint (acromioclavicular joint). That’s the spot where your collarbone meets your shoulder blade. If you feel pain right on the very top of your shoulder, that’s likely the AC joint taking too much "shear" force. Or it could be the long head of the biceps tendon, which runs right through the front of the shoulder and gets absolutely thrashed when your shoulders cave forward at the bottom of a rep.
The "Hidden" Role of the Scapula
Your shoulder blade (scapula) is the foundation of the push up. If the foundation moves like a rusty hinge, the house falls down. During a push up, your shoulder blades should move through a full range of motion. They need to "protract" (spread apart) at the top and "retract" (squeeze together) at the bottom.
A lot of guys and girls keep their shoulder blades pinned or, worse, let them "wing" out like little bird wings. When the scapula doesn't rotate properly, the humerus has nowhere to go but into the sensitive soft tissue of the joint. You've gotta let those blades move.
Why Your Form is Probably Killing Your Progress
Let’s get real about form. Most of us learned push ups in PE class from a coach who cared more about the number of reps than the quality of the movement.
- The Elbow Flare. This is the big one. If your body looks like a capital "T" from above, you’re asking for a rotator cuff tear. Your elbows should be tucked at roughly a 45-degree angle. Think of your body as an arrow, not a T.
- The "Hiking" Shoulder. People get tired and their shoulders creep up toward their ears. This closes the joint space and puts massive strain on the upper traps.
- The Sagging Core. If your hips sag, your pelvis tilts, and your ribcage drops, it changes the angle of the shoulder joint relative to the floor. It forces the shoulder into "internal rotation" at the worst possible moment—the bottom of the move.
Dr. Kelly Starrett, author of Becoming a Supple Leopard, often talks about "torque." If you aren't creating external rotation torque—basically trying to "screw" your hands into the floor—your shoulder isn't "set" in the socket. It’s just floating. And floating joints under load get injured.
Is it Tendonitis or Just "Old Man" Shoulders?
Usually, it’s Tendinopathy. We used to call everything "Tendonitis" (inflammation), but we now know it’s often "Tendonosis" (degeneration of the collagen). If your shoulder pain with push ups feels worse in the morning and gets "warmed up" as you move, it’s likely a tendon issue. If it’s a sharp, lightning-bolt pain that stops you mid-rep, that’s more likely a labral tear or acute impingement.
Don't just pop ibuprofen and keep going. Masking the pain with NSAIDs while continuing the mechanical error is a great way to end up in a surgical suite.
How to Test Your Shoulder Health at Home
Try the "Empty Can" test, but carefully. Extend your arm out to the side at a 45-degree angle, turn your thumb down toward the floor, and have someone apply light downward pressure. If that causes a sharp pain in the shoulder, your supraspinatus (a rotator cuff muscle) might be pissed off.
Another one is the "Cross-Body Lead." Pull your arm across your chest like a stretch. If the pain is on the very top of the shoulder, think AC joint. If it’s deep inside, think labrum or impingement.
These aren't medical diagnoses. Go see a PT. But they help you narrow down why you're hurting.
Fixing the Issue: The Protocol
You don't necessarily have to stop doing push ups forever. You just have to stop doing them poorly.
1. The Hand Placement Hack
Try rotating your hands slightly outward. Instead of middle fingers pointing straight ahead, let them point slightly to the 10 and 2 o'clock positions. This naturally encourages the elbows to tuck and puts the humerus in a much safer, externally rotated position.
2. Regress to Progress
If a standard push up hurts, do them on an incline. Use a bench or a Smith machine bar. Reducing the percentage of body weight you’re pushing allows you to focus on "scapular rhythm"—that squeezing and spreading of the shoulder blades—without the sheer panic of your face hitting the floor.
3. Build the Back
Most people have shoulder pain with push ups because they are "front-dominant." They do 100 push ups and 0 rows. You need to strengthen the rhomboids and the lower trapezius. If your back is weak, your shoulders will naturally roll forward (protract), which makes impingement almost inevitable. For every pushing set, do two pulling sets. Face pulls, I-Y-T raises, and seated rows are your best friends.
✨ Don't miss: Mediterranean diet 30 day meal plan pdf free printable: What most people get wrong about starting
The Role of Myofascial Release
Sometimes the "pain" in the shoulder isn't the shoulder at all. It’s a tight pec minor. The pec minor is a small muscle that sits under your big chest muscle. When it gets tight, it pulls the scapula forward and down (anterior tilt). This effectively "locks" the shoulder in a position where it's going to rub against the bone.
Take a lacrosse ball. Pin it between your chest (near the armpit) and a wall. Lean in. If you find a spot that makes you want to see God, stay there for 90 seconds. Softening the front of the chest can often "open up" the shoulder joint instantly.
When to See a Doctor
Stop. Do not pass go if:
- Your shoulder feels "loose" or like it's slipping out of the socket.
- You have night pain that wakes you up.
- You have significant weakness (e.g., you can't lift your arm to brush your hair).
- The pain persists for more than two weeks despite rest and form changes.
A 2017 study published in the Journal of Physical Therapy Science noted that scapular stabilization exercises significantly reduced pain and improved function in patients with impingement. It’s not just "bro-science"; the data backs up the need for a stable base.
Actionable Steps to Pain-Free Pushing
Fixing shoulder pain with push ups isn't about one "magic" stretch. It’s a systematic overhaul.
- Immediate Change: Stop doing "wide-grip" push ups. Bring your hands to shoulder-width and keep those elbows tucked to your ribs.
- The 2-Second Pause: At the top of every push up, actively "push the floor away" to spread your shoulder blades. At the bottom, "pull" yourself down and feel your blades touch.
- Warm-up properly: Spend 5 minutes on "Band Dislocates" and "Scapular Push ups" (where you only move the shoulder blades, not the elbows).
- Check your neck: Don't reach for the floor with your chin. Keep a "double chin" or a neutral neck. "Poking" your neck forward shifts your center of mass and puts extra strain on the shoulder girdle.
- Vary the stimulus: Switch to "Neutral Grip" dumbbell presses for a few weeks. The neutral grip (palms facing each other) is the most shoulder-friendly pressing position known to man.
If you follow these adjustments, you aren't just managing pain; you're building a more resilient upper body. Shoulder health is a long game. Don't sacrifice your 50-year-old shoulders for a 20-year-old's ego.